Needle Pain/Acute & Chronic Pain

Question 1

What is the importance of vaccinations?

Answer 1

vaccination saves lives
-reduced morbidity and mortality in adults, children, and other vulnerable populations
without vaccination –> outbreaks of disease
protect those who are immunized around them
-infants and other patients who cannot be immunized for medical reasons

Question 2

What are the barriers to vaccine uptake?

Answer 2

socioeconomic:
-low-income and education level
-young parental age
-birth order of infants
-previous poor vaccine experience
-other significant life stressors
geographic/systematic:
-long distance to clinics
-clinic hours
-translation

Question 3

Why do vaccine dosages differ for children?

Answer 3

limited by the amount of volume that can be administered intramuscularly

Question 4

What is the patient age at which pharmacists can drugs by advanced method?

Answer 4

5 and older

Question 5

Pharmacists arent involved in routine vaccination of children, but how can we be involved?

Answer 5

plan for vaccinations - plant the seed
how to prevent needle pain
address concerns

Question 6

What are some non-pharm therapies for needle pain?

Answer 6

breastfeeding:
-strongly recommended in children 2 and younger
-reduces stress through multiple mechanisms
-cost neutral, can bottle feed
positioning during vaccination (not supine on table)
-skin to skin for neonates
-rocking or holding infants
-children sitting up
distraction:
-key for older children
-games, TV, book, bubbles
-vibration: Buzzy, finger tapping

Question 7

What are some pharmacological options for needle pain?

Answer 7

topical anesthetics (lidocaine, prilocaine)
sucrose solution

Question 8

For which age group can we use topical anesthetics for needle pain?

Answer 8

12 and younger

Question 9

What is the benefit of topical anesthetics for needle pain?

Answer 9

dulls needle pain for the patient

Question 10

How should topical anesthetics be applied for needle pain?

Answer 10

apply before going to the clinic
-onset time differs between products
read product monograph

Question 11

What can help increase the absorption of topical anesthetics?

Answer 11

occlusion

Question 12

For which age group can we use sucrose solution for needle pain?

Answer 12

2 years and younger

Question 13

What is the MOA of sucrose solution for needle pain?

Answer 13

unknown but thought to involve release of endogenous opioids

Question 14

How can sucrose solution be made at home?

Answer 14

mix 1 packet of sugar with 2 teaspoons of water
-then draw up syringe and give a few drops on tongue

Question 15

True or false: even if all the pharmacological and non-pharmacological options are used for needle pain, not all the pain can be prevented

Answer 15

true

Question 16

What are the consequences of acute pain in children?

Answer 16

avoidance of medical care later in life
chronic pain
-mental illness, opioids, SES disparities
increased health system costs
infants/children identified as high risk of inequitable and poor-quality pain management

Question 17

Describe the pathophysiology of pain in children.

Answer 17

nociceptive system has increased excitability and sensitization when compared to adults
greater degree of plasticity
descending inhibition is delayed
exaggerated reflex responses which can cause sensitivity
perception of pain may be more influenced by developmental, social, and psychological factors

Question 18

How can we asses pain in children?

Answer 18

developmentally appropriate tool
-repeat assessment post-intervention
-self report instead of proxy (caregiver) when possible

Question 19

What are some examples of pain scales?

Answer 19

numeric rating scale (NRS-11)
color analogue scale (CAS)
faces pain scale-revised (FPS-R)

Question 20

How should we observe pain in pre or non-verbal children?

Answer 20

observational pain measures:
-changes in facial expressions, cry, irritability, sleep disturbance, inactivity
-use in tandem with caregiver who is familiar with the child

Question 21

What is the non-pharm approach to pain in paeds?

Answer 21

3 P’s (physical, psychological, pharm)

Question 22

What are the first line options for acute pain in paeds?

Answer 22

ibuprofen or acetaminophen
-pick a suitable dosage form and dose
-monotherapy or co-therapy for more severe pain
ibuprofen more effective

Question 23

What is an important tool when escalating therapy for acute pain in children?

Answer 23

opioids
-never use codeine
-combine with non-opioid
-three days or 5-10 doses

Question 24

Describe good monitoring for acute pain in kids.

Answer 24

assess pain at first encounter and then regular assessment
use same scale each time

Question 25

What is chronic pain?

Answer 25

pain for greater than 3 months

Question 26

What are the most common forms of chronic pain in paeds?

Answer 26

headache
abdominal
MSK

Question 27

What is the evidence for neuropathic pain in paeds

Answer 27

limited